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1.
J Craniofac Surg ; 35(5): e458-e461, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39042059

RESUMO

Functional endoscopic sinus surgery consistently benefits from good anatomical knowledge and modern imaging techniques. Ethmoid air cells migrate in specific topographical sites near the ethmoid. Posterior ethmoid air cells that descend into the maxillary sinus (MS) are ethmomaxillary sinuses (EMSs) that into the superior nasal meatus. Few previous studies found EMSs in 0.68% to 16.48% of cases. An EMS differs from a Haller's infraorbital cell nearing the ethmoidal infundibulum. A posterior ethmoid air cell intercalated between the ethmoid, MS and sphenoidal sinus is a Sieur's cell, but it could also be regarded as an EMS. An EMS should be discriminated from a maxillary recess of the sphenoidal sinus. An EMS could determine Onodi's maxillary bulla into the MS. The false duplicate MS described by Zuckerkandl consists of a MS draining into the middle nasal meatus adjoined by an EMS draining into the superior nasal meatus. These are separated by the ethmomaxillary septum. The latter may be confused with an intrasinus septum of the MS if the drainage pathways are not adequately documented. Therefore, a case-by-case anatomic identification of the pneumatic spaces nearing the MS should be performed before surgical endoscopic approaches of the nose and sinuses.


Assuntos
Endoscopia , Seio Etmoidal , Seio Maxilar , Humanos , Seio Maxilar/anatomia & histologia , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/cirurgia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/anatomia & histologia , Endoscopia/métodos , Tomografia Computadorizada por Raios X , Masculino , Feminino
2.
Artigo em Chinês | MEDLINE | ID: mdl-38858119

RESUMO

Objective:To investigate the criteria for selecting surgical approaches for frontal and ethmoid sinus osteomas of different locations and sizes on CT imaging. Methods:Using sagittal and coronal CT images, the following lines were delineated: the F-line(a horizontal line passing nasofrontal beak), the M-line(a vertical line passing paries medialis orbitae), and the P-line(a vertical line passing the center of the pupil). Classification of frontal and ethmoid sinus osteomas was based on their relationship with these lines. Appropriate surgical approaches were selected, including pure endoscopic approaches, endoscopic combined with eyebrow incision approach, and endoscopic combined with coronal incision approach. This method was applied to a single center at the Third Affiliated Hospital of Sun Yat-sen University for endoscopic resection of frontal and ethmoid sinus osteoma. Case Data: Sixteen cases of ethmoid sinus osteomas were treated from January 2020 to September 2023. Among these cases, there were 9 males and 7 females, with ages ranging from 18 to 69 years, and a median age of 48 years. Results:Thirteen cases underwent pure endoscopic resection of the osteoma, while in three cases, a combined approach was utilized. Among the combined approach cases, two exceeded both the M-line and the F-line but did not cross the P-line; therefore, they underwent endoscopic combined with eyebrow incision approach. One case exceeded all three lines and thus underwent endoscopic combined with coronal incision. In all cases, complete resection of the osteoma was achieved as per preoperative planning, and none of the patients experienced significant postoperative complications. Conclusion:For frontal and ethmoid sinus osteomas, it is advisable to perform a thorough preoperative radiological assessment. Based on the size of the osteoma and its relationship to the three lines, an appropriate surgical approach should be chosen to optimize the diagnostic and treatment plan.


Assuntos
Endoscopia , Seio Etmoidal , Seio Frontal , Osteoma , Neoplasias dos Seios Paranasais , Tomografia Computadorizada por Raios X , Humanos , Osteoma/cirurgia , Osteoma/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Seio Frontal/cirurgia , Seio Frontal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/diagnóstico por imagem , Adolescente , Tomografia Computadorizada por Raios X/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Endoscopia/métodos , Adulto Jovem
3.
BMJ Case Rep ; 17(6)2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926120

RESUMO

A patient in his 20s presented with a change in the appearance of his left eye with evidence of relative afferent pupillary defect. Imaging revealed a giant frontoethmoidal osteoma, a benign sinonasal tumour, invading three-quarters of the orbit. Multidisciplinary discussion involving opthalmology, maxillofacial surgery, neurosurgery and otolaryngology resulted in the decision to attempt entirely endoscopic excision of this lesion, which was performed with successful outcomes. This case demonstrates how a sinonasal osteoma should be considered in the differential diagnosis for a patient presenting with proptosis or other eye signs suggestive of compression of the orbital compartment. This case report and literature review highlights the possibility of managing giant sinonasal osteomas with orbital extension through a completely endoscopic approach.


Assuntos
Endoscopia , Osteoma , Neoplasias dos Seios Paranasais , Humanos , Osteoma/cirurgia , Osteoma/diagnóstico por imagem , Osteoma/patologia , Masculino , Endoscopia/métodos , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/patologia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia , Osso Etmoide/patologia , Neoplasias Orbitárias/cirurgia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/patologia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/patologia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Órbita/patologia , Seio Frontal/diagnóstico por imagem , Seio Frontal/cirurgia , Seio Frontal/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem , Exoftalmia/etiologia , Exoftalmia/cirurgia , Diagnóstico Diferencial , Adulto
4.
Medicine (Baltimore) ; 103(15): e37703, 2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38608083

RESUMO

RATIONALE: The present investigation documented a case of bilateral sinonasal inverted papilloma (SNIP) that arose from both sides of the frontal sinus and ethmoid sinus. The occurrence of bilateral involvement of the nasal cavities and frontal sinus is rather infrequent. PATIENT CONCERNS: Informed consent was obtained from the patient. DIAGNOSIS: Bilateral SNIP. INTERVENTIONS: The tumor was completely removed by Draf III endoscopic resection complemented by an external eyebrow arch approach, and the postoperative recovery was uneventful. OUTCOMES: The purpose of this paper is to present a comprehensive reference for the management of bilateral SNIP that affects the frontal sinuses. LESSONS: This study addresses the staging and surgical management of bilateral SNIP, along with a review of the factors contributing to its recurrence. The recommended treatment method involves applying the Draf III technique combined with an external nasal approach.


Assuntos
Seio Frontal , Neoplasias de Cabeça e Pescoço , Papiloma Invertido , Humanos , Seio Frontal/diagnóstico por imagem , Seio Frontal/cirurgia , Papiloma Invertido/cirurgia , Seio Etmoidal/cirurgia , Osso Frontal
5.
Kurume Med J ; 69(3.4): 195-199, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38233177

RESUMO

INTRODUCTION: To investigate the locations of the anterior, middle, and posterior ethmoidal foramina and their relationships to the frontoethmoidal suture. METHODS: One hundred twenty sides from sixty adult human skulls were used. Specimens with significant damage to the medial orbit wall were excluded. The number of ethmoidal foramina (anterior, middle, and posterior) on the medial orbital wall and the relationship of each foramen to the frontoethmoidal suture were recorded and classified as follows: Type I: superior to the frontoethmoidal suture; Type II: on the frontoethmoidal suture; Type III: inferior to the frontoethmoidal suture. RESULTS: Of the ninety-four sides, fourteen (14.9%) had one foramen, sixty-two (66.0%) had two , and eighteen (19.1%) had three. In total, 192 ethmoidal foramina were observed. Among the fourteen sides with one foramen, eight foramina were anterior and six were posterior. Among the 192 ethmoidal foramina, 162 were eligible for fur ther classification (74 anterior, 14 middle, and 74 posterior). Types I, II, and III ethmoidal foramina were found in 38.3% (62/162), 61.7% (100/162), and 0% (0/162), respectively. CONCLUSIONS: Our current study found a higher incidence of type I than previously reported. It is important to be aware of the significant incidence of foramen variations when the medial orbit wall is manipulated during surgery. Unless caution is observed, an inadvertent surgical injury can occur and lead to life-threatening complications. Therefore, a good understanding of orbital anatomy and its potential variations is critical for improving patient out comes.


Assuntos
Osso Etmoide , Osso Frontal , Humanos , Osso Etmoide/anatomia & histologia , Osso Etmoide/cirurgia , Osso Frontal/anatomia & histologia , Osso Frontal/cirurgia , Adulto , Cadáver , Órbita/anatomia & histologia , Órbita/cirurgia , Suturas Cranianas/anatomia & histologia , Masculino , Seio Etmoidal/cirurgia , Seio Etmoidal/anatomia & histologia , Feminino
6.
Ann Otol Rhinol Laryngol ; 133(2): 181-189, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37608702

RESUMO

OBJECTIVE: Variations in the upper attachment of the uncinate process (UP) are important because they can affect frontal sinus drainage and change the morphology. Functional endoscopic sinus surgery (FESS) is the primary technique used to treat chronic medically refractory rhinosinusitis. Uncinectomy is the basis of FESS technique to obtain the best possible result from surgery. The anterior ethmoidal artery (AEA) enters the nasal cavity through the orbital medial wall (lamina papyracea) may also be affected by the upper attachment of the UP. The aim of this study was to investigate a possible link between UP variations and the course of the AEA. MATERIALS AND METHODS: This retrospective, computed tomography (CT)-based, anatomic study was conducted on 200 healthy adults (100 females and 100 males) by screening bilateral paranasal sinus images. The upper attachment of the UP was classified in 6 types (1-6) based on the Liu classification. The AEA was divided into 4 types (A-D) based on location: anterior to the frontal sinus (A), between the frontal sinus and the middle nasal turbinate (B), and anterior to the posterior ethmoidal cells (C and D). All the CT images were evaluated simultaneously by 2 anatomists and 1 radiologist. RESULTS: Of the total cases (200 right and 200 left side), 48.8% were type 1 UP attachment, 11.0% type 2, 12% type 3, 9% type 4, 18% type 5, and 1.2% type 6. The AEAs were classified as 12.2% type A, 71.8% type B, 15.2% type C, and 0.8% type D. CONCLUSION: The course of the AEA through the nasal cavity was observed to shift anteriorly from the ethmoidal bulla to the frontal sinus in patients with UP attached to the lamina papyracea and middle turbinate. Remarkably, the AEA always coursed anterior from the middle nasal turbinate line.


Assuntos
Seio Frontal , Sinusite , Adulto , Masculino , Feminino , Humanos , Estudos Retrospectivos , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/cirurgia , Seio Frontal/diagnóstico por imagem , Seio Frontal/cirurgia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Doença Crônica , Artérias , Endoscopia
7.
Surg Radiol Anat ; 46(1): 19-25, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38062267

RESUMO

PURPOSE: Understanding ethmoid roof morphology is crucial to prevent complications in endoscopic sinus surgery. This study aimed to evaluate the morphological properties of the ethmoidal roof regarding gender and age differences using Keros and Yenigun classifications on high-resolution computed tomography images. METHODS: We retrospectively analyzed 891 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in coronal sections and the anterior-posterior length in axial planes. The study retrospectively examined CT images of paranasal sinuses of patients living in the eastern Anatolian region of Turkey. RESULTS: In both Keros and Yenigun Classifications, the most common class was type 2, and the least common class was type 3. According to Keros et al.'s method, no significant difference was observed between men and women (p = 0.698). However, according to Yenigun et al., the average values of women in terms of the anterior-posterior distance of the ethmoid roof were significantly higher than men (p = 0.001). When examined according to age, a very low, negative correlation was revealed regarding Keros and Yenigun classifications (p = 0.047 and p < 0.001 retrospectively). According to Keros and Yenigun's classification, there was no significant difference between the left and right sides (p = 0.488 and p = 0.919, respectively). CONCLUSION: The morphological properties of the ethmoidal roof have importance to be considered for preoperative planning. Studying larger patient groups and meta-analyses that gather various research results about this subject might help better understand the ethmoidal roof morphology among populations.


Assuntos
Osso Etmoide , Seios Paranasais , Masculino , Humanos , Feminino , Estudos Retrospectivos , Turquia , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/anatomia & histologia , Tomografia Computadorizada por Raios X , Seios Paranasais/anatomia & histologia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/anatomia & histologia
8.
Eur Arch Otorhinolaryngol ; 281(3): 1293-1299, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37870642

RESUMO

PURPOSE: The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. This study aimed to evaluate the course of AEA according to the Keros classification and the presence of supraorbital ethmoid cell (SOEC) and to prevent possible complications by emphasizing the importance of preoperative paranasal computed tomography (CT) imaging. This approach will increase the effectiveness of endoscopic sinus surgery and improve patient safety. METHODS: The paranasal CT scan images of patients aged > 18 years between October 2020 and November 2021 from our center were retrospectively analyzed. The images were primarily evaluated in the coronal plane, and the sagittal and axial planes were utilized to evaluate variations in AEA regarding the skull base. Furthermore, the relation of AEA course with Keros classification and SOEC was evaluated. The study included 1000 patients aged 18-80 years (right and left, a total of 2000 samples). RESULTS: Grade 3 AEA was the most common regarding the skull base. Keros Type 2 was the most common classification. Overall, 48.7% patients had SOEC. The incidence of Grade 3 AEA was higher among patients with SOEC and a higher Keros classification compared with those without SOEC and a lower Keros classification. Furthermore, Keros Type 3 was the most associated with SOEC presence. CONCLUSION: Consistent with the literature, the probability of Grade 3 AEA in patients with high Keros classification and SOEC was significantly higher in our study. Therefore, we consider that preoperative imaging according to Keros classification and SOEC presence can predict AEA course and guide surgery.


Assuntos
Seio Etmoidal , Base do Crânio , Humanos , Estudos Retrospectivos , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/irrigação sanguínea , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Artéria Oftálmica , Tomografia Computadorizada por Raios X , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/cirurgia
9.
Am J Otolaryngol ; 45(2): 104133, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38039908

RESUMO

OBJECTIVES: To evaluate the impact of facility volume on outcomes following primary endoscopic surgical management of sinonasal squamous cell carcinoma (SNSCC). METHODS: The 2010-2016 National Cancer DataBase (NCDB) was queried for patients diagnosed with T1-T4a SNSCC surgically treated endoscopically as the primary treatment modality. Factors associated with overall survival (OS) were evaluated, including facility volume. RESULTS: A total of 330 patients who underwent endoscopic surgical management of SNSCC were treated at 356 unique facilities designated as either low-volume (LVC; treating 1-2 cases; 0-75th percentile), intermediate-volume centers (IVC; 3-4 cases total; 75th-90th percentile), or 144 high-volume (HVC; treating 5+ cases total; >90th percentile) centers. HVC treated patients with higher T staging (42.1 % vs. 29.8 %) and tumors in the maxillary sinus (26.9 % vs. 13.2 %) and ethmoid sinus (10.3 % vs. ≤8.3 %), while LVCs treated lower T stage tumors (70.2 % vs. 57.9 %) and tumors that were located in the nasal cavity (70.2-78.5 % vs. 62.8 %). On multivariable analysis, factors associated with decreased OS included higher T stage (T3/T4a vs. T1/T2; OR 1.92, 95 % CI 1.06-3.47) and older age (>65 vs. <65; OR 2.69, 95 % CI 1.62-4.49). Cases treated at high-volume centers were not associated with a higher likelihood of OS when compared to low-volume centers (OR 0.70, 95 % CI 0.36-1.35). CONCLUSIONS: HVC are treating more primary tumors of the maxillary and ethmoid sinuses and tumors with higher T stages with endoscopic approaches, although this does not appear to be associated with increased OS. SHORT SUMMARY: Sinonasal squamous cell carcinoma (SNSCC) presents late in disease process with poor prognosis. We investigated the impact of facility volume on outcomes following endoscopic treatment of SNSCC. High-volume centers treat more advanced and complex disease with comparable OS.


Assuntos
Carcinoma de Células Escamosas , Neoplasias dos Seios Paranasais , Humanos , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Neoplasias dos Seios Paranasais/cirurgia , Neoplasias dos Seios Paranasais/patologia , Cavidade Nasal/patologia , Seio Etmoidal/cirurgia , Estudos Retrospectivos
10.
Laryngoscope ; 134(3): 1096-1099, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37578267

RESUMO

OBJECTIVE: The anterior ethmoidal artery (AEA) is an important structure to identify during endoscopic sinus surgery. Although identification on imaging is easily taught, a consistent endoscopic landmark for the AEA, independent of anatomic ethmoid cell variation, is lacking, leaving many surgeons unclear about the exact location without dependence on navigation. Here, we describe a consistent endoscopic landmark, regardless of anatomical ethmoid variation. METHODS: We prospectively enrolled adult patients undergoing endoscopic surgery involving frontal and ethmoid sinuses in this observational study. The AEA landmark was defined simply as the septation or ridge one step back along the ethmoid skull base from the posterior table of the frontal sinus. The gold standard to calculate the sensitivity of our endoscopic landmark was an image-navigation system, registered to within 1.5 mm accuracy, locating the AEA within three planes. Both endoscopic and computerized tomography (CT) images of the pointer at the landmark were taken simultaneously. The concordance of endoscopic to navigation images was independently assessed by three blinded rhinologists. RESULTS: Forty patients were included in our study with 73 sides analyzed. Diagnoses included chronic rhinosinusitis without polyps (52.5%), with polyps (22.5%), recurrent acute sinusitis (15%), sinonasal tumors (7.5%), and odontogenic sinusitis (2.5%). The AEA was accurately identified using our endoscopic landmark in 97.3% of the cases (71/73). Of the two cases in which the AEA was not found within the landmark, the artery was located ≤1 mm posteriorly. CONCLUSION: We describe a consistent endoscopic landmark to identify the AEA, conserved across various clinical diagnoses and anatomic variations in sinus structure. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:1096-1099, 2024.


Assuntos
Sinusite , Base do Crânio , Adulto , Humanos , Base do Crânio/cirurgia , Artérias/cirurgia , Osso Etmoide , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/irrigação sanguínea , Endoscopia/métodos
11.
Acta Med Acad ; 52(2): 105-111, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37933507

RESUMO

OBJECTIVE: To reveal the reliability of radiological measurements of the ethmoid arteries. METHOD: Five fresh frozen cadaveric heads underwent computed tomography and endoscopic sinus surgery. The lateromedial length of the anterior ethmoidal artery (AEA) and its distance to the axilla of the middle turbinate (MTA), the sphenoethmoidal recess (SR) and the posterior ethmoidal artery were measured. The posterior ethmoidal artery (PEA) was referenced to the SR. These anatomical parameters were measured both radiologically and endoscopically, and the compatibility of the two was examined. RESULTS: Ten nasal cavities were dissected. We found that the distance of MTA to the AEA was 16±8 mm in dissection, 21±4 mm radiologically in the sagittal section, the distance of SR to the AEA was 14±3 mm in dissection, 19±4 mm radiologically in the sagittal section, and the distance of the AEA to the PEA was 10±3 mm in dissection, 12±3 mm radiologically in the axial section. The distance of the PEA to SR was 6±3 mm in dissection, 8±2 mm radiologically in the sagittal section. CONCLUSIONS: The distance of the AEA to the MTA, the distance of the AEA to the PEA and the distance of the PEA to the SR were compatible with each other in the dissection and in the radiologically evaluation, whereas the distance of the AEA to the SR was not compatible.


Assuntos
Artérias , Seio Etmoidal , Humanos , Reprodutibilidade dos Testes , Seio Etmoidal/irrigação sanguínea , Seio Etmoidal/cirurgia , Tomografia Computadorizada por Raios X , Cadáver
12.
Eur Ann Otorhinolaryngol Head Neck Dis ; 140(6): 313-316, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37891149

RESUMO

The paranasal sinuses play a role in producing and storing nitric oxide (NO). NO is a powerful antiviral and antibacterial gas which may be involved in the non-specific immune defenses of the respiratory tract. Conducted by the inspiratory current at the alveolar-capillary membrane, it increases pulmonary venous blood oxygenation. NO is actively released in the form of independent boluses in the respiratory tract, thanks to a sphincter function that can be identified during ethmoidectomy under general anesthesia. Safeguarding paranasal sinus physiology necessarily involves conserving this ostial sphincter function, which is essential to the respiratory role of the paranasal sinuses. Although it has not yet been demonstrated that the destruction of this ostial function has measurable consequences for respiratory function, it makes sense to avoid systematic antrostomy and to preserve this ostial function whenever possible, depending on the clinical conditions. This technical note describes step-by-step how to conserve the maxillary ostium, in the example of radical ethmoidectomy with mucosal ablation for nasal polyposis (nasalization). It is illustrated by two videos. The discussion focuses on the respective indications for ostial preservation and middle meatotomy (antrostomy).


Assuntos
Pólipos Nasais , Seios Paranasais , Humanos , Seios Paranasais/cirurgia , Seio Etmoidal/cirurgia , Pólipos Nasais/cirurgia , Respiração , Seio Maxilar/cirurgia
13.
J Investig Med High Impact Case Rep ; 11: 23247096231201013, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37737575

RESUMO

A 41-year-old woman showed a palpable mass at the superonasal orbital edge on the right side. Magnetic resonance imaging demonstrated a lobulated fluid-containing tubular mass which extended anteriorly to posteriorly along the medial orbital wall, nasal to the eyeball. She was followed once a year for 8 years until the age of 49 years when she decided to undergo surgical resection because of the enlarged mass. The lobulated large mass was resected and the pathology showed sparsely distributed spindle cells, positive for CD34, in alcian blue-positive mucous substances, indicative of myxoma. Postoperative magnetic resonance imaging showed residual lobulated tubular mass along the optic nerve on the medial side and superior to the eyeball. The residual orbital mass showed stable structure with more evident connection with the ethmoid sinus lesion, suggestive of the ethmoid origin, in 12 years until the age of 61 years. In the review of 20 patients with orbital myxomas in the literature, in addition to this case, roughly classified locations in the orbit were retrobulbar in 8 patients, on the lateral side of the orbit in 4, on the superior side in 6, on the medial side in 1 (this patient), and in the orbit with no specific description in 2. In pathological examinations, immunohistochemistry was not done in 8 patients, done but all negative in 2, and positive in 11 patients: nerve sheath myxoma was diagnosed in 3 patients based on positive S100 staining. Orbital myxoma is rare but considered in differential diagnosis of orbital masses.


Assuntos
Seio Etmoidal , Mixoma , Adulto , Feminino , Humanos , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Mixoma/diagnóstico por imagem , Mixoma/cirurgia
14.
Eur Arch Otorhinolaryngol ; 280(12): 5401-5406, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37552283

RESUMO

PURPOSE: Understanding the anatomy of the paranasal sinuses and their variations is essential to achieving safe and effective endoscopic sinus surgery. The ethmomaxillary sinus (EMS) is a relatively under-researched anatomical variation. This study investigated the prevalence, clinical features, and effect of EMS on the maxillary sinus in comparison with Haller's cells. METHODS: Patients who visited the Rhinology Clinic at our hospital for rhinologic symptoms between January 2020 and December 2020. Computed tomography (CT) scans of paranasal sinuses were obtained at 1 mm-section thickness. Using CT scans, we investigated the clinical features of EMS, measured maxillary sinus volume, and analyzed the presence of maxillary sinusitis. RESULTS: EMS was observed in 26 of the 250 patients (10.4%). The male-to-female ratio was equal. The age ranged from 18 to 83 years (mean age, 56.3). Of the patients with EMS, 65.4% were unilateral and 34.6% were bilateral. The prevalence of Haller's cells was similar to that in EMS (10.8%). In the analysis of patients with unilateral EMS, the EMS side was found to have a significantly reduced maxillary sinus volume compared to the opposite side, whereas the difference was not significant in Haller's cells. There was no significant relationship between EMS or Haller's cells and maxillary sinusitis. CONCLUSIONS: EMS can significantly affect maxillary sinus volume. Therefore, surgeons should thoroughly review PNS CT scans before paranasal sinus surgery to determine the presence and features of EMS.


Assuntos
Sinusite Maxilar , Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Sinusite Maxilar/diagnóstico por imagem , Sinusite Maxilar/cirurgia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/anatomia & histologia , Seio Maxilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Endoscopia
16.
Klin Onkol ; 36(2): 146-149, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37072250

RESUMO

BACKGROUND: Osteomas of the paranasal sinuses occur rarely in the pediatric population, we find only a few reference of symptomatic osteomas in the literature. Opinions on the indication for surgical treatment are controversial. CASE: The authors present a case of symptomatic osteoma of the right ethoimoidal sinus in a 12-year-old boy, who was treated surgically, with endoscopic endonasal approach. The symptomatology, diagnosis and therapy of these tumors in the pediatric patient are discussed. CONCLUSION: Osteomas of the paranasal sinuses are slow-growing benign lesions. Symptomatic osteomas can grow expansively and cause serious complications. The treatment of osteoma is surgical and the endoscopic approach offers the possibility of removal with cosmetic benefits.


Assuntos
Osteoma , Neoplasias dos Seios Paranasais , Masculino , Humanos , Criança , Seio Etmoidal/cirurgia , Seio Etmoidal/patologia , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Neoplasias dos Seios Paranasais/cirurgia , Endoscopia , Tomografia Computadorizada por Raios X , Osteoma/diagnóstico por imagem , Osteoma/cirurgia
17.
Artigo em Chinês | MEDLINE | ID: mdl-36987953

RESUMO

Objective:To evaluate the efficacy of glucocorticoid sinus stents implanted 2 weeks after functional endoscopic sinus surgery(FESS) for the treatment of chronic rhinosinusitis with nasal polyps(CRSwNP). Methods:CRSwNP patients with similar bilateral lesions were randomly divided into two groups, with a stent group of 25 patients and a control group of 24 patients. Patients in the stent group had glucocorticoid sinus stents implanted into the bilateral ethmoid sinuses 2 weeks after FESS, while the control group underwent postoperative debridement only. Follow-up assessments occurred at postoperative weeks 2, 4, 8, and 12. Patients were asked to assess their sensation of nasal symptoms using a 10-point visual analog scale. Efficacy was assessed by endoscopic evaluations. Sinus obstruction, crusting/coagulation, polyp formation, middle turbinate position, adhesions, mucosa epithelialization, and postoperative intervention were assessed as efficacy outcomes. GraphPad Prism 9 was applied for statistical analysis. Results:At 4 and 8 weeks postoperatively, the stent group showed significant improvement in VAS scores of nasal congestion and runny nose compared with the control group(P<0.05). No significant difference was observed in the VAS scores of head and facial stuffiness, loss of smell, or nasal dryness/crusting between the two groups(P>0.05). Compared with the control group, the stent group had a lower rate of polypoid formation at 4, 8, and 12 weeks postoperatively. At postoperative week 12, the rate of mucosal epithelialization in the ethmoid cavity was significantly higher in the stent group. During the follow-up, the frequency of postoperative intervention was significantly lower in the stent group than in the control group(P<0.05). Besides, a lower incidence of middle turbinate lateralization was found in the stent group at 8 and 12 weeks postoperatively. At 8 weeks postoperatively, the stent group had a percentage of adhesion lower than that of the control group(all P<0.05). Conclusion:Implantation of glucocorticoid sinus stents after FESS can maintain sinus cavity patency, improve the inflammatory status of the operative cavity, reduce postoperative interventions, and promote benign regression of the operative cavity.


Assuntos
Pólipos Nasais , Seios Paranasais , Rinite , Sinusite , Humanos , Pólipos Nasais/cirurgia , Seio Etmoidal/cirurgia , Glucocorticoides/uso terapêutico , Rinite/cirurgia , Sinusite/cirurgia , Seios Paranasais/cirurgia , Endoscopia , Stents , Doença Crônica , Resultado do Tratamento
18.
J Laryngol Otol ; 137(12): 1368-1373, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36919671

RESUMO

OBJECTIVE: This study aimed to develop and evaluate a low-cost orbital prosthesis for simulation of endoscopically assisted intra-orbital anterior ethmoidal artery ligation. METHODS: A low-cost orbital prosthesis was built and evaluated by ENT surgical trainees. Feedback was given following the assessment in the form of a face validity questionnaire. RESULTS: Results were scored on a Likert scale of 1-7 (low to high). Trainees had limited exposure to the procedure (40 per cent) and predominantly low levels of confidence (mean, 3.67) that correlated with a lack of first-hand experience. The anatomy and likeness to human tissue of the prosthesis were both ranked highly, with mean scores of 5.0 and 4.93, respectively. CONCLUSION: The results of this study support the idea that a simple anatomical prosthesis for the simulation of endoscopic anterior ethmoidal artery ligation can be created with potential value to otolaryngology surgical training. To the authors' knowledge, this is the first documentation of simulated surgical epistaxis management using an artificial anatomical model.


Assuntos
Seio Etmoidal , Artéria Oftálmica , Humanos , Seio Etmoidal/cirurgia , Seio Etmoidal/irrigação sanguínea , Artéria Oftálmica/cirurgia , Endoscopia , Epistaxe/cirurgia , Ligadura/métodos
19.
Surg Radiol Anat ; 45(5): 545-554, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36939871

RESUMO

PURPOSE: The anterior ethmoidal artery is a major surgical landmark that is susceptible to iatrogenic injury during surgery of the anterior ethmoidal sinus, frontal sinus, and skull base. The present study aimed to define the location of the anterior ethmoidal artery in relation to specific anatomical landmarks using radiological imaging and endoscopic dissection. METHODS: Eighty-six anterior ethmoidal arteries were assessed using computed tomography scans (bilateral analyses) and forty anterior ethmoidal arteries were assessed using cadaveric specimens (bilateral analyses). The skull base, anterior nasal spine, anterior axilla of the middle turbinate, and nasal axilla were morphometrically analysed to determine their reliability as anterior ethmoidal artery landmarks. RESULTS: Distances to the skull base, anterior nasal spine, and nasal axilla displayed statistically significant differences between sexes and sides (p < 0.05). All landmarks demonstrated excellent reliability as anatomical landmarks for the localisation of the anterior ethmoidal artery, radiologically and endoscopically (ICC values ranged from 0.94 to 0.99). CONCLUSION: The middle turbinate axilla was the most reliable landmark, due to the lack of statistically significant differences according to sex and laterality, and the high inter-rater agreement between measurements. Anatomical knowledge of variations and relationships observed in the present study can be applied to surgeries of the anterior ethmoidal sinus, frontal sinus, and skull base to improve localisation of the anterior ethmoidal artery, preoperatively and intraoperatively, and avoid iatrogenic injury of the vessel.


Assuntos
Seio Etmoidal , Artéria Oftálmica , Humanos , Reprodutibilidade dos Testes , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/cirurgia , Seio Etmoidal/irrigação sanguínea , Conchas Nasais/diagnóstico por imagem , Conchas Nasais/cirurgia , Endoscopia/efeitos adversos , Endoscopia/métodos , Cadáver , Doença Iatrogênica
20.
J Clin Neurosci ; 110: 7-11, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36780783

RESUMO

OBJECTIVES: We investigated supraorbital ethmoid cell (SOEC) presence and types in paranasal sinus computed tomography (PNSCT). METHODS: The PNSCT images of 188 adult patients (93 males and 95 females) were evaluated as SOEC group (n = 87 sides), and non-SOEC group (n = 289 sides, control). In both groups, anterior ethmoid artery (AEA) notch-ethmoid roof distance and presence of AEA canal were evaluated. In the SOEC group, SOEC types (type 1 to 3) and SOEC angle are also examined. RESULTS: SOEC was detected in 87 sides (23.13 %). SOEC type 2 was the most detected type (71.3 %). AEA notch-ethmoid roof distance of the SOEC group was significantly higher than those in the non-SOEC group. AEA notch-ethmoid roof distance of the SOEC Type 3 group was significantly higher than SOEC Type 2 group. AEA notch-ethmoid roof distance was 3.74 ± 1.81 mm in the SOEC group and 0.68 ± 1.16 mm in the non-SOEC group. When SOEC types were considered, this distance was 5.29 ± 2.66 mm in type 3, 3.35 ± 1.35 mm in type 2 and 3.48 ± 0.92 mm in type 1. In higher SOEC types, SOEC angle; and AEA notch-ethmoid roof distance increased. CONCLUSION: In more pneumatized SOEC presence, SOEC angle increase, and AEA notch-ethmoid roof distance increases, AEA runs inferiorly in the ethmoid cells and freely below the skull base; and is more susceptible to injury. The surgeons should be more careful not to damage AEA in the FESS when detecting well-pneumatized SOECs (SOEC Type 3).


Assuntos
Seio Etmoidal , Seios Paranasais , Adulto , Masculino , Feminino , Humanos , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/irrigação sanguínea , Seio Etmoidal/cirurgia , Osso Etmoide/diagnóstico por imagem , Base do Crânio , Artérias/diagnóstico por imagem , Endoscopia/métodos
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